An Assessment of Culture in Orthopaedic Surgery


Ann E. Van Heest, MD


Kristy L. Weber, MD

AAOS conducts a survey on work environment and culture

Culture in the workplace is the personality and character of our profession, reflecting the values, attitudes, and beliefs of orthopaedic surgeons. Recent high-profile cases have highlighted discrimination, bullying, sexual harassment, and harassment occurring in multiple professions, businesses, and organizations. The culture within the surgical community is particularly susceptible to harassment and discrimination, given the marked gender and racial disparities within the community.

The Royal Australasian College of Surgeons (RACS) has taken the lead in assessing and addressing workplace culture in surgery. After identifying the high prevalence of disruptive behavior within RACS, it launched a program to promote respectful behavior and required all RACS members to undergo training, including a diversity and inclusion plan, as well as a building respect/patient safety plan.

This summer, AAOS conducted a survey that assessed aspects of the U.S. orthopaedic culture. The 2018 Work Environment and Culture Survey was a collaborative effort initially developed by representatives from AAOS (the Diversity Advisory Board [DAB] and Women’s Health Advisory Board), Ruth Jackson Orthopaedic Society, Pediatric Orthopaedic Society of North America, American Orthopaedic Association, and Perry Initiative.

The survey examined the prevalence of:

  • discrimination—treating a person with an identified attribute or personal characteristic less favorably than a person who does not have that attribute or characteristic
  • bullying—a behavior or pattern of behaviors that a reasonable person would expect to victimize, humiliate, undermine, or threaten a person to whom the behavior is directed
  • sexual harassment—an unwelcome sexual advance, request for a sexual favor, or other unwelcome conduct of a sexual nature by which a reasonable person would be offended, humiliated, or intimidated
  • harassment—an unwanted, unwelcome, or uninvited behavior that makes a person feel humiliated, intimidated, or offended

The survey was sent to a subset of its most at-risk members, identified as female or underrepresented minorities (URMs) from all member categories. The survey was intentionally distributed to all women and URMs in the AAOS active/candidate/resident membership to assess the concerns of those orthopaedic surgeons. A matched set of male members was surveyed for comparison. The response rate was 16 percent. Among the 2,322 women and 3,912 men surveyed, the sex-specific response rates were 27 percent and 9 percent, respectively. The response rate of URM members was difficult to assess, as most did not indicate ethnicity. Thirty percent of the respondents had been in practice more than 20 years, and 24 percent had been in practice one to five years.

The findings

Discrimination was reported at a much higher rate in females (84 percent) than in males (59 percent). Females also reported higher rates of bullying, harassment, and sexual harassment. African-American and Hispanic members reported a higher rate (85 percent) of discrimination than Caucasian members (78 percent). However, more than 50 percent of all AAOS members who completed the survey—males and females of all races, ethnicities, and ages—reported that they have experienced discrimination and bullying. Survey results also indicated that more than 50 percent of female and 10 percent of male members have experienced some form of sexual harassment. Similarly, between a quarter and a third of members who completed the survey said they have experienced harassment.

Interestingly, discrimination was reported more frequently by members in practice 11–20 years (86 percent) and 0–10 years (85 percent) compared to older members (77 percent) and residents (69 percent).

When the survey asked what actions are required to assist in the prevention of such behaviors in the current workplace, the most prevalent response—mentioned by 70 percent of respondents—was greater leadership by surgical department/division heads and supervisors. At least 50 percent wanted better support mechanisms and resources to support more effective compliance and resolution procedures in the workplace. Females were more likely than males to report that such actions are needed. The least popular action mentioned was further training from their hospital/health system (36 percent).

Respect for patients, colleagues, and ourselves is an important building block of the profession. This survey provides baseline data to use as we move toward building a safer and more inclusive work culture in the healthcare space.

Next steps

Diversity and inclusion in orthopedic workplaces and culture are nonnegotiable. And this survey, which suggests there is an alarming level of unacceptable behavior, provides the first step to understanding the problem. In the past 12 months, the Academy has offered relatable education via symposia, webinars, AAOS Now articles, and more. However, the DAB will continue to assess the survey’s data and consider additional programming to increase awareness and facilitate improvements. The survey’s executive summary is available at www.aaos.org/about/protected/environmentculturesurvey.aspx. If you have suggestions as to how the AAOS can continue to support a more positive workplace culture, please email ideas to diversity@aaos.org.

Ann E. Van Heest, MD, is a professor, vice chair of education, and residency program director in the Department of Orthopaedic Surgery at the University of Minnesota.

Kristy L. Weber, MD, is a professor and vice chair of faculty affairs in the Department of Orthopaedic Surgery at the University of Pennsylvania, as well as first vice-president of AAOS.

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